Insulin sensitivity and insulin secretion in lean and obese normal pregnant women.

An insulin-modified frequently sampled intravenous glucose tolerance test with minimal model analysis was performed in normal pregnant women between 28-32 weeks of gestation, to assess insulin sensitivity and insulin secretion. Insulin sensitivity in the pregnant group (no. 26) was reduced to approximately 50% that of nonpregnant group (no. 27) (p < 0.05). This increased insulin resistance was compensated by an enhancement of the first phase of insulin secretion, which was increased more than twofold in the pregnant women when compared with the nonpregnant women (p < 0.05). There was a trend toward greater insulin resistance and insulin secretion in the obese pregnant women (no. 7) as compared with the lean pregnant women (no. 19) although this difference was not statistically significant. Our findings confirm that late pregnancy is a state of physiologic insulin resistance compensated by an increase of insulin secretion.

Effect of cyclospasmol on early diabetic retinopathy.

A randomized, double-blind, placebo controlled study to investigate the long-term effect of Cyclospasmol (cyclandelate) on the abnormal permeability of the blood-retinal barrier was performed in 26 patients with insulin-dependent diabetes mellitus for at least 1 year and minimal retinopathy. Cyclospasmol 400 mg or placebo capsules were taken 4 times daily for 12 months by equal numbers in both groups. Each patient underwent a routine ophthalmoscopic examination, retinal fluorescein angiography and quantitative vitreous fluorophotometry to assess the permeability of the blood-retinal barrier just before the trial and following 6 and 12 months of therapy. Laboratory tests for determining blood and urine glucose levels and blood HbA1-levels were also carried out at these assessments. Statistically significant changes in diabetic control, in HbA1-levels or in the frequency of retinal microaneurysms could not be shown in either treatment group during the trial, nor were there any significant differences in these parameters between the two groups. Analysis of fluorophotometric data on fluorescein penetration into the left posterior vitreous demonstrated significant reductions in this parameter during the trial compared to the pretreatment level in Cyclospasmol treated diabetics. These changes in the pretreatment level after 6 and 12 months also differed significantly between the two groups. However, this statistically significant beneficial reduction in fluorescein penetration into the left posterior vitreous did not occur in the right eye in the Cyclospasmol group. In placebo treated patients a consistently deleterious trend for this parameter was observed for both eyes during the one year study.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of sorbinil on blood-retinal barrier in early diabetic retinopathy.

To study the effect of sorbinil on the alteration of the blood-retinal barrier, 32 adult-onset, non-insulin-dependent diabetic patients with minimal or no retinopathy were randomly assigned to receive either oral sorbinil (250 mg once a day) or a placebo for 6 mo. All patients underwent fundus photography, fluorescein angiography, and vitreous fluorophotometry before treatment and at 3 and 6 mo after treatment. Vitreous fluorophotometry data showed that the alteration of the blood-retinal barrier increased significantly less in the sorbinil-treated group compared with the placebo group during the 6-mo study period. Side effects were limited to hypersensitivity reactions, with skin rash and fever, in only 2 of the 16 patients who received the drug. These hypersensitivity reactions disappeared with discontinuation of the medication. Aldose-reductase inhibition may play an important role in stabilization of the blood-retinal barrier in early diabetic retinopathy.

Effect of sulindac on the permeability of the blood-retinal barrier in early diabetic retinopathy.

To study the effect of sulindac on the alteration of the blood-retinal barrier, 24 insulin-dependent diabetic patients with minimal or no retinopathy were randomly assigned to receive either oral sulindac (200 mg twice daily) or a placebo for a period of six months. All patients underwent fundus photography, fluorescein angiography, and vitreous fluorophotometry before treatment and after 1, 3, and 6 months of treatment. Vitreous fluorophotometry data showed that there were fewer alterations of the blood-retinal barrier in the sulindac group compared with the placebo group during the six-month study period.

Detection of early retinal changes in diabetes by vitreous fluorophotometry.

A series of 77 patients with overt diabetes and with apparently normal fundi on ophthalmoscopy and fluorescein angiography was examined by vitreous fluorophotometry. Breakdown of the blood-retinal barrier, which appears to be the earliest clinically detectable change in the retina in diabetes, was a constant finding. Quantitative measurement by vitreous fluorophotometry of the breakdown of the blood-retinal barrier could be correlated with degree of metabolic control and previous duration of diabetic disease. Significantly higher vitreous fluorophotometry values, indicating a more marked breakdown of the blood-retinal barrier, were recorded in patients under poor metabolic control than in patients whose diabetes was under relatively better control. Similarly, patients who has had diabetes for longer periods of time showed higher vitreous fluorophotometry values than those recorded in patients with diabetes of shorter duration.

A follow-up study by vitreous fluorophotometry of early retinal involvement in diabetes.

A series of 25 diabetic patients who showed apparently normal fundi on ophthalmoscopy and fundus fluorescein angiography were observed by using vitreous fluorophotometry for 30 months. The results showed that the alteration of the blood-retinal barrier increased generally during the follow-up period, particularly in the diabetic patients who were under poor metabolic control. The degree of breakdown of the blood-retinal barrier was significantly associated with the duration of the diabetic disease.